When it comes to health care, we quite honestly don't know what to think.
Or rather, we don't know what our health care strategy would be if we ever wanted to or had to go back to the U.S.
We have insurance now... excellent insurance, in fact. And even if we didn't, we wouldn't have to get U.S. insurance to avoid the new penalties under the Affordable Care Act. According to the IRS, U.S. citizens who live abroad at least 330 days of the year (like us) will be treated as if they have qualifying insurance coverage and won't owe any tax penalty... and that's true regardless of whether they actually have health insurance in the country where they live.
In many places overseas, not only is your health care more affordable, your lifestyle
can be healthier.
Photo courtesy of InternationalLiving.com
But the insurance we have is international insurance, and we would cease to qualify for it if we moved back to the U.S. Our plans right now don't include going back to the U.S., but life is what happens while you're busy making plans...
So we went to healthcare.gov to explore our options for health care plans under the new Affordable Care Act.
And could find out next to nothing.
We found that comparison shopping for health care plans under the new system is impossible without actually opening an account. We don't even know who this account is with... we assume it is with a government agency, but we have no idea which one.
But because we don't currently need U.S. insurance, we have no intention of opening an account in any case.
Which, we discovered, makes it impossible to compare the actual, final rates for various plans, because without an account, you can't see the specific figures for premiums adjusted for the number of family members or any discounts or tax breaks that might apply to any specific plan.
So we really have no idea exactly what health care in the U.S. would cost us in any particular location. However, we can tell, gleaned from the general plan premiums you can see at healthcare.gov without opening an account, that it almost certainly would cost us significantly more than we're paying now for comparable coverage outside the U.S.
Which doesn't surprise us. We can look up the rankings just as easily as anyone else, and we know that the U.S. has some of the most expensive health care on the planet.
We also know that, in study after study and index after index, the quality of U.S. health care rarely even breaks into the Top 10 compared to other countries around the world. The last study by the World Health Organization ranked the U.S. at 15th in overall performance and first in overall expenditure per capita. Combining the two factors put the U.S. in 37th place in the WHO study.
That was more than a decade ago, and the controversy over the findings was so great that the WHO declined to do such rankings any more. But a more recent Bloomberg study ranked the U.S. even lower when comparing price of health care to efficiency and quality of service... 46th in fact... the worst value for price in health care of any country in the developed world.
And in the time since both of these studies, we certainly haven't seen any general decrease in the cost of U.S. health care or any measurable improvement in its general quality or availability, even under the latest ministrations of the Affordable Care Act.
But that's just us, looking at things from abroad. Which, under the current health care circumstances in the U.S., is pretty much where we want to be right now.
A number of organizations offer accreditation for international hospitals, which then must strive to meet standards for conditions, ranging from architectural design to hygiene. The Joint Commission International sets quality standards for hospitals that participate in its program of review.
Has the doctor done this procedure before? Is he or she used to working with patients from overseas? For how many years has this doctor been performing this procedure and how many has he or she done?
Find a doctor in the United States with whom you can follow up if complications arise, as some physicians don't like being tasked with taking care of someone else's mistakes, says Dr. Douglas Lundy. "Make sure you've identified more follow-up care and be sure that you have a doctor who's engaged and supportive," adds IndUSHealth's Rajesh Rao. "The last thing you want to do is find a doctor who is apprehensive."
The new doctor "took the time to call me from his home before I even went," says Fred Schuler, who in 2011 had a diskectomy in India. "He actually talked to my doctor in Springfield, Missouri, to tell him what he was going to do." This kind of dynamic is critical, according to IndUSHealth's Rajesh Rao. "Patients should actually talk to their doctors well before they sign up and lock in a deal," Rao says. "It's very important the doctor be sufficiently available and give you good advice and make you feel comfortable."
What is the overall success rate for this procedure or operation? What is this doctor's success rate? Make sure you're in the hands of the best possible physician. "If you're going for a heart bypass," says Josef Woodman, CEO of Patients Beyond Borders, "you want to know that particular doctor's done 300 of them instead of 20 and that that procedure has a 98.2 percent success rate," roughly comparable to the rate in the States.
Letting a doctor oversees gain access to your health history -- X-rays, prescriptions -- can make for a better transition of care. While it may be awkward to let a doctor in the States know about a planned treatment overseas, "you just have to do it," says Josef Woodman, CEO of Patients Beyond Borders. "You reduce your chances for complications to a minimum."
To stave off complications from surgery and provide continuous care, some countries require that a patient stay at least two weeks, until "the red zone has passed," says Patients Beyond Borders' Josef Woodman. Get an idea of what the recovery and rehabilitative care is expected to look like in your host country -- and back home -- to provide the best possible chance of pulling through unscathed.
Many hospitals provide luxury-level accommodations not only for the patient but for companions as well. "It's psychological and emotional leaving your family," says Josef Woodman of Patients Beyond Borders. "We recommend a companion join you if that's possible financially, to be an extra pair of eyes and ears, fetch prescriptions and make sure that things are okay."